Type A behaviour, hostility and CHD: Rise and fall of a good idea?

Reading There is material on Type A and hostility in the standard texts and general papers. See also Johnston DW The current status of the coronary prone behaviour pattern. J. Roy. Soc. Med. 86, Dated (but short). Matthews, K Coronary heart disease and Type A behaviors: update on and alternative to the Booth-Kewley and Friedman (1987) quantitative review. Psychol. Bull. 104, Plus reply Interesting discussion of Type A as risk factor. Worth reading Miller et al 1991 Reasons for the trend toward null findings in research on Type A behaviour. Psychol. Bull, 110, Serious stuff, follows up on Matthews.

reading (cont.) Miller TQ et al, A meta-analytic review of research on hostility and physical health. Psychol. Bull., 119, A comprehensive review. Best read after Matthews. Dont get bogged down in tables.

Type A Behaviour (Friedman & Rosenman) Characterised by: Competitiveness Time Urgency Hostility

Questions from Structure Interview to Measure Type A Behaviour 1. Does your job carry heavy responsibility? 4. Are you satisfied with your present job? 6. When you play competitive games with children do you purposely let them win? 13. Do you get impatient when you are watching a slow worker? 14. Do you often do two things at a time, like reading while eating?

Western Collaborative Group Study Rosenman, Brand, Jenkins, Friedman & Straus men aged 30-59yrs classified on Structured Interview as either Type A or Type B Extensive measurement of other risk factors Followed up initially for 8.5 years for evidence of CHD, i.e., prospective study

Were Type As more likely to experience CHD? Type AType B Number No. with CHD Incidence (annual per 1000)

Could other risk factors explain the Type A & CHD link? Analysed using multivariate statistics but also by simpler stratified analysis. Effects still present. See incidence rates for MI (39-49) Type A Type B Non smokers Smokers Normotensives Hypertensives Low Cholesterol High Cholesterol

What happened to the WCGS later? Ragland & Brand 1988 studied survival of 257 men who had experienced CHD in original 8.5 yr follow up Ragland,DR,Brand,RJ,(1988) Type A behaviour and mortality from coronary heart disease. The New England Journal of Medicine 318, Ragland & Brand 1988 looked at mortality over 22 years in original sample Ragland,DR,Brand,RJ (1988) Coronary heart disease mortality in the Western Collaborative Group Study: follow-up experience of 22 years. American Journal of Epidemiology,127,

Ragland & Brand, 1988

Ragland & Brand, 1998

Williams et al, 1988

Mechanisms linking Type A or Hostility and CHD Could be any of the mechanisms we discussed linking stress and CHD CV reactivity : extensively studied. Mixed finds Effects of clotting process (Markovitz) Other (see Kop)

Intervention evidence (Important in establishing causality) Usual texts. Also chapter by Krantz & Lundeman on Cardiovascular disorders in Johnston & Johnston good on interventions (& other parts of course). See also Krantz & McCeney Annual Rev Psychol : There is discussion of interventions in CHD in Schiederman, Antoni, Sabb & Ironson (2001) Health Psychology: psychosocial and biobehavioural aspects pf chronic disease management. Annual Rev Psychology, 52: Especially

Friedman,M,Thorensen,CE,Gill,JJ,Powell,LH,Ul mer,D,Thompson,L,Price,VA,Rabin,DD,Breall,W S,Dixon,T,Levy,R,Bourg,E( 1984) Alteration of Type A behaviour and reduction in cardiac recurrences in postmyocardial infaction patients American Heart Journal,108,237,248

Recurrent Coronary Prevention Project (RCPP- Friedman & Thoresen, 1985) Questions Can Type A behaviour be reduced? Does reducing Type A reduce risk of recurrent MI Design Patients who had experienced an MI Type A Change + cardiac care (592) Cardiac care only (270) Outcomes Type Behaviour New MI